Medication-Assisted Treatment in a Residential Setting: How Starbridge Approaches MAT for Dual Diagnosis
Published by Starbridge Recovery | California Dual Diagnosis Residential Treatment
Medication-assisted treatment (MAT) remains one of the most evidence-supported, underutilized, and frequently misunderstood components of substance use disorder treatment. In residential treatment settings specifically, MAT policy varies widely — from programs that actively integrate it as a clinical standard to programs that prohibit it entirely, sometimes citing a philosophy of "medication-free recovery" that has no grounding in current clinical evidence.
For referring clinicians and families making placement decisions for patients with opioid use disorder, alcohol use disorder, or other conditions for which evidence-based medications exist, a program's MAT policy is not a secondary consideration. For certain patients, it is the most clinically significant question to ask.
This article describes Starbridge Recovery's approach to MAT within the context of dual diagnosis residential treatment — including what we support, what the evidence shows, and why this matters for the patients we serve.
What Medication-Assisted Treatment Is
The term medication-assisted treatment (MAT) refers to the use of FDA-approved medications, in combination with counseling and behavioral therapies, to treat substance use disorders. The most established MAT applications are:
For opioid use disorder (OUD):
- Buprenorphine (Suboxone, Subutex, Sublocade): a partial opioid agonist that reduces cravings and withdrawal symptoms, available in sublingual, buccal, and extended-release injectable formulations
- Methadone: a full opioid agonist dispensed through licensed opioid treatment programs (OTPs), highly effective for patients who have not responded to buprenorphine
- Naltrexone (Vivitrol): an opioid antagonist that blocks the effects of opioids, available orally or as a monthly extended-release injection; appropriate after detoxification
For alcohol use disorder (AUD):
- Naltrexone: reduces craving and the reinforcing effects of alcohol
- Acamprosate: reduces protracted withdrawal symptoms including anxiety and restlessness
- Disulfiram: creates an aversive reaction to alcohol, used in selected patients with high motivation
What MAT is not: It is not "substituting one addiction for another." This characterization — still prevalent in some treatment contexts — is not supported by clinical evidence and perpetuates a stigma that has caused measurable harm to patients with OUD who were steered away from effective treatment. Buprenorphine and methadone, when used as prescribed for OUD, reduce illicit opioid use, reduce overdose mortality, reduce criminality, and improve retention in treatment. They are medications treating a medical condition.
The Clinical Evidence for MAT
The evidence base for MAT in OUD is among the strongest in all of addiction medicine:
SAMHSA's 2024 NSDUH data found that among the approximately 4.8 million people with opioid use disorder in the United States, only 17 percent received medications for OUD (MOUD) in the past year. This treatment gap is not explained by lack of evidence — it is explained by stigma, programmatic barriers, and the legacy of abstinence-only treatment philosophies that have not caught up with the clinical literature.
The clinical evidence is clear: MOUD significantly reduces illicit opioid use, reduces overdose mortality by 50 to 70 percent in some studies, improves treatment retention, and reduces criminal recidivism. The American Society of Addiction Medicine, the American Psychiatric Association, SAMHSA, and virtually every major clinical organization with a position on OUD treatment recommend MOUD as a first-line treatment.
For alcohol use disorder, naltrexone and acamprosate have both demonstrated efficacy in reducing relapse and supporting sustained abstinence in randomized controlled trials. The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management explicitly notes that withdrawal management alone is not treatment for AUD — it is the beginning of treatment, and pharmacotherapy for the underlying disorder should be initiated as part of a comprehensive treatment plan.
MAT in the Context of Dual Diagnosis Residential Treatment
For dual diagnosis patients — those presenting with both a substance use disorder and a co-occurring psychiatric condition — MAT considerations are more complex than for single-diagnosis SUD presentations.
Drug-drug interactions. Some psychiatric medications interact with OUD medications. Buprenorphine, for example, carries a risk of serotonin syndrome when combined with certain antidepressants and requires clinical awareness of sedation risk when combined with benzodiazepines. These interactions are manageable with clinical oversight; they require a prescriber with the competency to navigate them.
Psychiatric symptom management in early recovery. For patients with depression, anxiety, PTSD, or mood disorders, the early weeks of recovery involve neurochemical shifts that can exacerbate psychiatric symptoms. A dual diagnosis residential program that manages both psychiatric medications and MAT simultaneously — with a prescriber who understands both domains — is providing integrated pharmacological management that a program with only addiction medicine or only psychiatric coverage cannot match.
Medication-assisted treatment and the "abstinence" framework. Some patients, families, and residential treatment philosophies define "sobriety" in ways that exclude prescribed medications — creating clinical and ethical tension when a patient's evidence-based treatment plan includes buprenorphine or methadone. Starbridge's position is grounded in the clinical evidence: a patient taking buprenorphine as prescribed for OUD is in recovery, not in active addiction. Treatment plans that require discontinuation of MOUD to meet an ideological definition of abstinence are clinically contraindicated and carry real risk of overdose death at discharge.
Starbridge's MAT Policy
Starbridge Recovery accepts patients on MAT at admission and does not require discontinuation of buprenorphine, methadone (via coordinated OTP dosing), or naltrexone as a condition of admission or continued treatment.
For patients who arrive without MAT and for whom MAT is clinically indicated — particularly patients with moderate to severe OUD or AUD — our psychiatric and medical staff can initiate MAT during the residential stay as part of an integrated treatment plan.
Our approach to MAT is:
Evidence-based. Medication decisions are driven by clinical evidence, individual patient assessment, and the prescribing clinician's judgment — not by program philosophy or ideological commitments that are inconsistent with current clinical standards.
Integrated with behavioral treatment. MAT is not a standalone intervention at Starbridge. It is one component of a comprehensive dual diagnosis treatment plan that includes individual therapy, group programming, psychiatric management, and discharge planning.
Transparent with referral sources. If a patient's MAT needs fall outside our clinical scope — for example, a patient who requires methadone dosing through an OTP that cannot be coordinated during a residential stay — we are direct about that limitation and work with the referral source to identify a more appropriate placement.
Planned through discharge. For patients on MAT, discharge planning specifically includes confirmed MAT continuation — a prescriber identified, an appointment scheduled, and a prescription or program in place before the patient leaves our facility.
What This Means for Referring Clinicians
When you refer a patient with OUD to a residential program, you should ask directly: Does this program accept patients on buprenorphine? Will it require my patient to discontinue their medication? What is the clinical rationale for the program's MAT policy?
A program that requires MOUD discontinuation as a condition of admission is requiring a patient to accept clinical risk — increased craving, destabilization, and dramatically elevated overdose risk at discharge — in order to access residential treatment. For a patient with a dual diagnosis and complex psychiatric history, that risk is compounded.
Starbridge Recovery does not require that choice. We serve patients as they are, medically and psychiatrically — and we treat them with the full clinical tool kit that evidence-based medicine provides.
Starbridge Recovery is a DHCS-licensed, Joint Commission-accredited dual diagnosis residential program in California, accepting out-of-state referrals. For clinical inquiries and admissions, [contact our team].
References
- SAMHSA. (2024). Key Substance Use and Mental Health Indicators: 2024 NSDUH. https://www.samhsa.gov/data/
- ASAM. (2020). Clinical Practice Guideline on Alcohol Withdrawal Management. https://www.asam.org/quality-care/clinical-guidelines/alcohol-withdrawal-management-guideline
- NIAAA. (2024). Recommend Evidence-Based Treatment: Know the Options. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/recommend-evidence-based-treatment-know-options
- ASAM. (2023). The ASAM Criteria, Fourth Edition. https://www.asam.org/asam-criteria
- CDC. (2024). Health Center Visits by Adults With Opioid Use Disorder, United States, 2023. https://www.cdc.gov/nchs/products/databriefs/db544.htm